[Hiring] Utilization Management Clinical Processor @LE701 Avesis, LLC

Role Description

As a Utilization Management Clinical Dental Processor, you will leverage your dental clinical expertise to review dental x-rays and documentation, assessing medical necessity for prior authorizations.

• Perform initial reviews of medical necessity cases, ensuring compliance with member eligibility and covered services outlined in each client contract.
• Utilize clinical criteria to approve or deny services based on authorization.
• Evaluate service requests and determine their appropriateness, assessing the necessity of treatments prior to provision.
• Apply national clinical criteria and maintain up-to-date knowledge of relevant laws, regulations, and organizational policies.
• Complete 13 to 18 cases per hour to meet client standards and contractual obligations.
• Complete clinical scripts, review patient histories, and import supporting documentation into the internal system.
• Work hours may vary based on location, department needs, and workflow; mandatory overtime may be required during peak seasons.

Qualifications

• High School Diploma/GED
• Dental Assistant or Dental Hygienist required
• Dental Assistant certificate or 2 years of chair side assisting
• 1-2 years of experience reviewing dental x-rays, models, photos, and patient charts required
• Proficiency with Microsoft Office and other Windows-based applications
• Strong reading, writing, and professional communication skills
• Ability to manage multiple tasks and prioritize work
• Adaptability to handle multiple and changing priorities
• Effective time management and organizational skills
• Access to reliable internet connection (25 MBPS upload/50 MBPS download speed) and an appropriate workspace are essential for success in this remote role.

Requirements

• X-Ray certification is highly preferred.
• Knowledge of Medicare, Medicaid, or commercial insurance.
• Experience with HCPCS, CPT, CDT, and ICD-10 coding.

Benefits

• Meaningful and challenging work opportunities to accelerate innovation in a secure and compliant way.
• Competitive compensation package.
• Excellent medical, dental, supplemental health, life and vision coverage for you and your dependents with no wait period.
• Life and disability insurance.
• A great 401(k) with company match.
• Tuition assistance, paid parental leave and backup family care.
• Dynamic, modern work environments that promote collaboration and creativity to develop and empower talent.
• Flexible time off, dress code, and work location policies to balance your work and life in the ways that suit you best.
• Employee Resource Groups that advocate for inclusion and diversity in all that we do.
• Social responsibility in all aspects of our work.